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As a rule, I’ve kept my posts on this blog focused on my cancer experience and on my personal, random reflections. It’s a little awkward to write about other people in such a public forum. However, I have my wife Dorothy’s OK to get personal in public. Why did I wait?

For a little background mood music, I’m adding a song from an awesome songwriter, David Bridie, who started out with an Australian band called Not Drowning, Waving and then moved on to co-found My Friend the Chocolate Cake. I came across this song a couple years ago and it speaks to me of my respect and awe for the woman I married. (Just click to hear a live version of the song.)

More Heart Than Me

Dorothy and I met in 1984. I was a lonely, unfocused graduate student living in my grampa’s house, half-heartedly working on a Master’s in French and uncertain about my future. We’re not exactly sure when and how we first met, except that we both attended a Mormon student ward (congregation for single adults) at the University of Utah, and at the time she was finishing a B.A. in English; I was a French teaching assistant and worked for Dialogue: A Journal of Mormon Thought. We must have passed each other in the halls at church many times, but at some point she found out about my Dialogue connection and I found out she had just been published in Sunstone magazine. Must have been in August, when I was manning the Dialogue sales table at the Sunstone Symposium in Salt Lake and recognized Dorothy from church.

Shortly before the start of fall term, I was asked to speak in sacrament on the pretentious subject of “gospel scholarship.” I’d never been up on that podium before and remember very little about what I said. (And in retrospect, I feel bad that I missed out on Dorothy’s opportunity to speak in church in another student ward, when she was assigned to speak on personal hygiene. She borrowed an oversized toothbrush and hinged set of teeth from her dad’s dental practice and demonstrated proper brushing techniques, among other things.)

What I do remember after I spoke in church was that an engaging young woman walked up to me, complimented me on my talk and my charcoal wool blazer, and couldn’t resist reaching out to TOUCH my jacket. She kinda stroked it a little, then looked mildly apologetic, smiled, and disappeared into the crowd.

We do remember a few other early moments, but the chronology is uncertain. Dorothy substitute-taught a Sunday School class one day, which I quite enjoyed. We’d see each other at ward gatherings, like a “Mingle or Stay Single” lunch one Fast Sunday. On that day, Dorothy’s forward nature made an impression when she broke out of line, fork in hand, and helped herself to a baked potato I was holding on a paper plate. I didn’t know any of the women in the ward so well that I’d allow such familiarity. It was refreshing.

So we became casually acquainted. My friend Clay and I talked about Dorothy, as single young men do, and he encouraged me to step forward. But I was painfully shy and had enough trouble with the idea of a personal, working-my-way-up-to-a-date relationship, let alone being forward with someone who intimidated me with her smarts, humor, and relaxed manner.

Still, it was fated. As it turns out, Clay became my accomplice in what must stand as one of the worst first dates in history. At the time I drove a ’72 Dodge Dart that had been handed through the family, and in the dead of winter this car had no functioning heater. I didn’t mind so much, but I hadn’t considered whether it would be an inconvenience to a fellow traveler. In early February, Clay and I agreed to host a casual get-together at his house in Kaysville, a 20-minute drive from Dorothy’s apartment in Salt Lake. True to form, I didn’t quite manage to invite anyone else (I still have issues with organizing group activities). Clay’s girlfriend didn’t even make it. But I convinced Dorothy that it was a party of sorts, and she agreed to go with me.

The temperature must have been about 10° Farenheit, and as we left in the dark evening Dorothy’s winter coat just didn’t keep her warm enough. So I suggested she open the glove compartment and look for a space blanket I had tucked in for emergencies. Yes, one of those flimsy metallic sheets that reflect back body heat. You can’t say I didn’t have a gallant streak. You also can’t say she was impressed. I think I caught a look of subtle desperation in her eyes as we trundled along I-15 in my dusty old car, with Dorothy trying to tuck a crinkly little piece of Mylar around her legs to keep from freezing.

And that only set the stage. Clay lived in a small house with his mother, her poodle, and a wind-up toy dog that found its way into the party. We were going to play a board game, possibly Trivial Pursuit, but with just the three of us that didn’t quite work out either. What stands out is how blithely Dorothy sailed through a short evening, not acting for a minute as if anything were seriously wrong. I remember is how she wound up the mechanical dog and held a conversation with it as it yapped and wobbled around on its stubby little legs. I tried not to laugh inappropriately, but Dorothy is a natural entertainer. Clay and I were laughing like fools and Dorothy just kept going.

I’ll never know how I got lucky enough for a second date. I’m quite sure Dorothy thought it was another memorable one-time fiasco in her dating career. But as spring broke in the city, we found ourselves crossing paths again. She lived only two blocks from my grampa’s house, and she’d go out jogging early in the morning on Eighth East, toward Liberty Park. I was rather surprised one morning, getting into my car for an early class, to hear her voice: “I think I just got flashed!”  It seems that at one of the duplexes up the street, a man stepped out on his porch in a bathrobe to pick up his newspaper and couldn’t resist showing, well, more than he should. I sympathized with her, trying to reassure her that it was a safe neighborhood.

And so it went. We talked more, she invited me to go running (kicked my butt, of course), I invited her over to Grampa’s house one evening for canteloupe and yogurt. We dated, and it was good dating. I started writing her notes and leaving flowers for her, and we had some memorable moments in that Dodge Dart once the weather warmed up. April and May were blissful months. Then a bit a of uncertainty entered the picture: Spring term was her last quarter working on her degree, and she had made plans to go on a long bike trip with her friends Lynda and Alan after graduating. I worried about whether we’d still see each other after she returned, and wondered how I would keep up with someone who had such ambition and a carefree ability to make things happen. But I think I’ll save the rest of the story for another day.

Over the last five years I’ve spent a lot of time searching: for advice, for answers, for some kind of framework to understand the crazy detour my life has taken. Dorothy and I have read a lot of books, articles, and web sites, looking for spiritual guidance and practical help.

For a while I kept a notebook in which I’d write out paragraphs that were meaningful to me. I’m a terribly unorganized reader: I’m constantly saying, “you know, I read this article about [whatever subject we’re talking about]” and I usually end up by saying, “now, where did I read that?” So I figured I better at least take notes of the really good stuff.

One book I found at the library several years back was Pema Chödrön’s The Places That Scare You. The title seemed appropriate at a time when I was constantly being flooded with anxiety about medical tests, results, and deciding what to do next. And the book was rewarding.  Ani Pema Chödrön is an American woman who became a Buddhist nun in the mid-1970’s and who has written several widely respected books. She is a teacher in the Buddhist monastic tradition and is the director of the Gampo Abbey in Nova Scotia.

I wrote down several paragraphs from The Places That Scare You in my notebook, because they were striking and challenging to my thinking. In some ways that book was my introduction to a different way of experiencing change and losses? Before I quote from it, two words need defining: bodhichitta is the enlightened mind, a place that is vulnerable and tender and lets us react in love to difficult or painful circumstances. The warrior that Pema refers to is the image she prefers for how we see ourselves: a person who is prepared each day to face new challenges, new circumstances, and who has a mind that looks at each day as an adventure. A warrior isn’t complacent and doesn’t try to stay in a safe, controlled environment.

Many of us prefer practices that will not cause discomfort, yet at the same time we want to be healed. But bodhichitta training doesn’t work that way. A warrior accepts that we can never know what will happen to us next. We can try to control the uncontrollable by looking for security and predictability, always hoping to be comfortable and safe. But the truth is that we can never avoid uncertainty. This not knowing is part of the adventure, and it’s also what makes us afraid.

Bodhichitta training offers no promise of happy endings. Rather, this “I” who wants to find security—who wants something to hold on to—can finally learn to grow up. The central question of a warrior’s training is not how we avoid uncertainty and fear but how we relate to discomfort. How do we practice with difficulty, with our emotions, for the unpredictable encounters of an ordinary day?

I don’t pretend to know much about Buddhist teaching, but I have found it stimulating and helpful as I try to reconcile my beliefs with the confusing realities of having a life-threatening illness. Last year I bought a copy of another book by Pema Chödrön, When Things Fall Apart, and again enjoyed the challenge of re-thinking my values as I read it.

While I try not to get caught in reading through a comparative religion focus, what intrigues me at the core of this book is the assertion that we may never find solid ground in a changing, difficult world. I’ve always thought the concept of being “grounded” meant that there’s a solid place under me that I can count on, and that I can stay focused on it to keep my bearings. The attitude that Pema Chödrön recommends is to stop trying to find solid ground and instead learn to adapt to constantly changing circumstances—to accept what she calls “groundlessness.” The always-ready warrior wakes up each day, not knowing what path will be taken or what events to prepare for. It is our readiness for change that can provide some peace of mind.

That’s a simplified way to describe it, but (to revert to a little comparative religion) it took me a while to get my head around that idea, especially given the Christian idea I’ve grown up with that faith is a solid rock on which one can stand when everything else is shifting. So I was a bit suspicious of this claim that there is no solid ground.

Other aspects of  Pema Chödrön’s teachings have worked their way into my attempts to find peace. There’s that basic tenet of Buddhist and other contemplative traditions, staying focused on the present moment, for example. It’s been a huge challenge for me to stop projecting fears into the future, especially given my fretful temperament. I’ve always been one to imagine catastrophic possibilities when something goes wrong. It takes a lot of conscious effort to stay in the moment rather than replay past events or imagine all the infinite possibilities of the future.

As I read When Things Fall Apart, every chapter is a new challenge (like every day is a new adventure). This book can be frustrating and sometimes a little oblique, but underneath there’s a generous spirit and sense of love that is reassuring—or at least as reassuring as you might expect from an author who somewhat playfully advises that we “abandon hope,” because hope is a feeling that is coupled with fear. When we try to hope, we are trying to hold on to something permanent, to get ground under our feet:

Hope and fear come from feeling that we lack something; they come from a sense of poverty. We can’t simply relax with ourselves. We hold on to hope, and hope robs us of the present moment. We feel that someone else knows what’s going on, but that there’s something missing in us, and therefore something is lacking in our world.

This book is written in a long, flowing style that makes it difficult to pull quotes and make a simple point. Ideas build on each other, one chapter leads into the next in a way that doesn’t allow for much skipping around. Maybe the best way to summarize it would be to quote a blurb on the back of the book:

Pema Chödrön’s radical and compassionate advice for what to do when things fall apart in our lives goes against the grain of our usual habits and expectations. There is only one approach to suffering that is of lasting benefit, Pema teaches, and that approach involves moving toward painful situations with friendliness and curiosity, relaxing into the essential groundlessness of our entire situation. In the midst of chaos, we can discover the truth and love that are indestructible.

That’s the kind of challenge I’ve found throughout this book. How does one stop long enough to observe with mindfulness when confronted with fear and anxiety? Is it really possible to examine pain and strong emotions with curiosity? While it can be a heady, slow read, I’ve found myself drawn to this book as one of my tools for finding a balance of peace in the conflicts of always-changing medical issues.

back in the beam

Five years after I thought I was done with external beam radiation, I found myself in the waiting room of the IMC radiation oncology center this morning. It’s a comfortable place, with frosted windows and blonde wood paneling, jigsaw puzzles scattered out on tables, and magazines, brochures, and “Look Good Feel Better” literature for women losing hair.

My old friends, the radiation tech crew, are still there. We bonded over 38 pelvic radiation treatments back in July-September of 2007, and now we have a shorter series of 12 whole-brain radiation treatments in the next couple of weeks.

This is, to say the least, an unexpected development.

Over the last two months I’ve had moments of dizzyness and blurred/crossed vision when standing up. Because we knew that I had tumors spreading up my spine and at the base of my skull, both my oncologists agreed that this looked like tumors spreading along the outside base of the skull, where they can press against nerves that end up in the ocular center of the brain. It started somewhat innocuously, and I didn’t think much of it. But through July the experience became more noticeable and episodes lasted longer.

So after my last trip to Vegas, we agreed that I needed an MRI to find out just what was going on. I made an appointment for that Wednesday and a follow-up with Dr. S to discuss the results two days later. Of course, the day after the MRI I came home to a phone message: “Dan, I really need to talk to you this evening.” Not the most comforting words to get on a phone message from your oncologist.

Instead of a clinic visit, I had an appointment with the radiation oncologist at IMC Friday. The MRIs showed three substantial tumors in the brain, with another smaller start-up about a quarter-inch wide.

WARNING: THE FOLLOWING PORTION OF THIS BLOG POST IS NON-HIPAA COMPLIANT

After we looked at the MRI slices on a screen with our new oncologist, Dorothy and I snapped a few photos off the screen just for a special souvenir. What else can you do when you’ve just been given such news? On the left below, between the eyes, an inch-sized tumor in the middle of everything, lurking above the pituitary gland. On the right, two tumors spreading out along the top left of the skull. I tried to find a glimpse of that third little starter, but don’t have a very clear image of it. It’s on the top right side of the skull.

Creepy, huh?

So I’m back in the external beam radiation room for a couple of weeks. It’ll take another few weeks after that to wait for results since radiation tends to act cumulatively and slowly. Maybe a little hair loss and skin burns along the way. And we will still keep up with the radium-223 trial to keep all the other bone mets at bay.

Really, what can I say except “another bump in the road”?

Seasons are becoming my preferred measure of time. I have trouble tracking individual days or weeks, and even months sometimes blur together. But I can look back over the last few years and a remember the gist of a season: the long, warm fall of 2009, followed by the crazy intense snowstorms of winter 2010. Summer 2011 was cold and rainy. Winter in early 2012 was unusually dry.

Treatments and side effects also feel seasonal. My clinical trials have lasted 4 to 6 months at a time, so I remember them as seasons: there’s the Tokai summer of 2010, when I was living with a bit of weight gain but few real side effects. That fall I had the crazy Provenge experience, an intense 6-week period when I had a permacath stuck in my chest and did leukapheresis followed by infusion, three times.

Exelixis XL-184 took two good seasons in 2011. The gastrointestinal side effects became more and more extreme in the spring, and that summer I was wasting away (lost 25 pounds) and eating an oddly austere diet (bottled peaches, steamed rice, toasted white bread. baked potatoes; no acidic foods, spices, onion, or garlic, and eventually no fiber or fats to speak of). Although I stayed reasonably active that summer, my hair and skin bleached out to a ghostly pale and my appetite dwindled. Any time I could eat something new, I’d latch onto it until I was sick of it: I had a couple weeks of craving sushi and udon noodle soup, but then my taste buds said NO MORE. It was an odd price to pay for seeing my bone mets reverse and disappear from the scans.

Last fall, my first chemotherapy made the season muted: starting in August, I had a schedule of infusion followed 4 days later by exhaustion, then two weeks of building up strength and mental clarity. Just when I’d be feeling decent, it was time for the next infusion. By November, I was moving slower and thinking in a cloud. With daily prednisone, I began regaining all that weight I lost with XL-184.

Winter 2012 started on 20 December 2011 with my first dose of Zytiga, also with prednisone. Within a couple of weeks I became ravenously hungry, my blood counts continued to drop towards anemia, and fatigue became a constant. Spring went by in a hazy blur, with me too tired to care about much of anything except getting to work every day (which, fortunately, was not a problem) and keeping ahead of pain with lortab. Weekends I’d lounge on the couch, catch up on old movies, doze off, whatever.

This has become the summer of the rice bag scrubs. In March our family spent a week in Hawaii thanks to a gift from some very generous friends, and even though I had to hold back on some activities, we had a great time. By that time, about 6 months of prednisone had fattened me up, and my hair hadn’t quite started to grow back, so the photos of me in Haleiwa are those of a pudgy, potato-headed white guy. White in the literal sense, after a long winter indoors.

Now it’s mid-July. Days are long and nights are warm. If not for the wildfires that are smoking up the air in northern Utah, life outdoors would be just about perfect. I should be out there. Instead, I’m flopped on the couch wearing blue pajama pants and the rice-bag scrub shirt I bought at the Aloha Stadium swap meet in Honolulu. Some guy is making a good living selling scrubs, shorts, and tote bags made from Japanese 100-lb rice bags, and of all the awesome souvenirs I could have brought home, I just had to have one of those rice bags. That, and a 3-D plastic picture of Jesus. I can’t explain that one. He just kept looking at me, so I plunked down my five bucks and brought home Jesus.

Since Zytiga started to fail me in May, things have been dicey. By April my PSA had dropped from nearly 300 to just under 100, the lowest it’s been in a year and a half. But then it crept back up a bit, then more, and in May and early June it was bouncing up and down in the 200-300 range again.

Happily, the Bayer expanded access trial of Alpharadin came through and I had my first treatment June 6. It had been difficult waiting for that, knowing that it was in the works but just out of reach for a couple of months. And those were months that saw my pain levels rise considerably, leading to a whole new level of pain med management: Celebrex for basic joint and bone pain, with Tylenol and/or Lortab for the little ups and downs. Then lots of Lortab as things intensified. After several major episodes of breakthrough pain, we added a 12-hour morphine pill to get me through the nights and through some particularly bad days. And then regular senna pills to counteract the constipation.

The good news is that two weeks after beginning Alpharadin, I cut way back on my pain meds during the days. I’ve even had a few nights where I skipped the morphine. Something good is happening here: I don’t know my PSA count from my July 3 labs (the day of my second Alpharadin treatment), but LDH is dropping (from a very high level) and AlkPhos is in normal range (it’s been high for months). We assume that PSA and CTC will also be down, but I’m not going to ask until my next visit. Not knowing is a luxury that I try to take advantage of whenever possible.

So 2012 is the summer of the rice bag scrubs. I’ve hardly been outdoors, and now that I’m trying to taper off the prednisone, I haven’t been doing much of anything. That’s one drug I could have done without, not because of side effects while taking it, but the frustration of trying to stop. My adrenals have pretty much shut down, so as I chip away at those little pills, shaving off a milligram or so, I alternate between flat-on-my-back exhaustion and nervous-hot-flash sweats. Boy, do I miss hiking, and swimming, even going for leisurely walks that last more than about ten minutes. Who’d have thought that prednisone could take me out as completely as chemo?

It’s odd that my rice-bag summer is reduced to little more than going to work, taking pain meds, and collapsing on the couch. I’m always apologizing for not having the energy to do things, and I try not to be judgmental: I can’t afford to look back, adding up what I’ve lost or thinking about what I could be doing. Those are dangerous thoughts. For five years I’ve been training myself to stay in the moment, first out of fear for what could happen, then out of sadness for what could have been. It’s too painful to count up the losses over those five years.

Last night we had a huge windstorm on the mountain, followed by a fresh, cool rainstorm after several days of 100-degree-plus heat and smoky air. What a beautiful break. We stepped out on the porch in the comforting purple twilight and finally felt cooled off, fully and happily. Maybe that’s as good as it’s going to get this summer, so I’m working on being patient. Baby steps with the pain meds, the prednisone tapering, and not overdoing the regrets. It’s been disappointing to not have more to give my family. I mean, I’m going to be a grampa in September, and here I am on a couch all summer long? I keep believing I’ll get my brain back and get back to swimming and walking, but until then…

It’s been five months since I have made any regular visits to Las Vegas, and oddly enough, I’ve kinda missed it. But I’m gearing up for a new clinical trial and getting back on the road to my cancer treatment home away from home.

It’s just not easy to explain briefly how my health has been, but I’ll try. Last August I started my fourth treatment, third clinical trial, with Dr V.  It combined Taxotere (a standard chemotherapy) with Lenalidomide. The chemo lasted until December (they actually pulled the Lenalidomide after a couple of months when they found no benefit in early trial data).

So starting mid-December, I was off chemo and had no new clinical trials ready to go. We decided to start with Zytiga (abiraterone acetate), a new drug that had been approved by the FDA in April 2011. Since there was no study protocol, I began seeing a new oncologist in Salt Lake who could monitor lab work and give me monthly injections of Xgeva (denosumab), a bone-repair treatment that was FDA-approved in November 2010.

Somewhat surprisingly, I had good results for four months on Zytiga. It was surprising because my first clinical trial (Tokai’s TOK-001) was a drug that is quite similar to Zytiga. It seemed likely that my cancer might have already learned from that one how to get around this particular drug, which inhibits the CYP17 enzyme that is “required for androgen biosynthesis” (try reading the official literature on this drug for some real fun). Essentially it blocks anything, prostate cancer cells included, that tries to build androgen hormones. I like to think of it as an intense hormone blocker that has turned me into a soft blob of a human being. Something between the Michelin man and Mr. Bill. And then add on white curly hair from my chemo-perm. I don’t look like myself, lately.

The thing is, Zytiga worked for me, probably because I had been on a fairly low dose of the Tokai drug. In December, my last CT & bone scans showed that I had somewhat extensive bone involvement with my cancer, in spite of the chemo; my PSA was in the 300 range. Since then we’ve only really checked PSA levels, and they dropped as low as 97 before rising a little (112) and then jumping up higher (186). So, it looks like there are cancer cells that have found a new way to survive.

For whatever reason, I’ve had to deal with extensive pain since the beginning of the year. Honestly, I don’t know what’s intensifying the pain. I assume it’s tumor activity in bones, but with my PSA dropping while the pain increases, that doesn’t seem to tell the whole story. It could be that Zytiga is part of the problem, since known side effects include joint swelling and pain, and muscle discomfort. The pain could be related to Xgeva which, like Zometa, can induce muscle pain and flu-like symptoms. Of course, no drug company wants to take responsibility for my pain, and with multiple things going on, there’s rarely a clear answer.

Happily, we’ve got a new clinical trial now that my PSA is rising. Bayer has partnered with a Norwegian company, Algeta, that developed a treatment called Alpharadin. It uses a form of radium-223 to deliver low-intensity radiation directly to cancer cells. It’s a smart idea that has improved on similar drugs like Samarium-153, which has been used since 1998 for pain management of bone metastases. Alpharadin is on track for FDA approval, and the best thing is that Bayer has opened up their phase III trial for compassionate use. This means that if you qualify, they’ll let you in on the trial so you don’t have to wait for the FDA to grant their magic stamp of approval.

So, I’ve got the paperwork done and it’s looking like I can start within a few weeks. I had a quick visit at the end of April with the doctor, and yesterday I saw the clinic’s radiation oncologist for a review of my treatment history to get everything OK’d. Now we just have to wait for the radium to be delivered from some secret location in Norway

So, Las Vegas, I’m coming back. Be good to me, OK?

unexpected beauty

Happened across this photo (and others) by Thomas Jackson. Quirky, fun, beautiful.

Cups by Thomas Jackson

Sort of like an urban counterpart to another artist, Andy Goldsworthy, who does amazing things with natural (and ephemeral) materials.

Horn (1986) by Andy Goldsworthy

Click that link for an excellent web site with photos of Goldsworthy’s early work. He does small, temporary work and monumental, more permanent creations as well. I love the descriptions of the pieces, which make it sound like he just wanders around, finding natural materials and making beautiful pieces of art, then photographing them.

Find beauty wherever and however you can.

Cable TV has never been a priority for me. I’m hopelessly old school and cheap when it comes to paying for entertainment. I believe this has been a source of some disappointment to my children, but we’ve never paid extra for TV channels. Actually, we do have a basic cable deal that we pay for, but it’s because we have no choice. We live in a community with an owners’ association, and everyone here is required to sign up for the community cable deal. One hundred-plus channels are available to us, and at any given time about one-hundred-plus channels are completely useless to me.

So if there’s a pay-cable series worth watching, I usually wait for it to come out on DVD, and then I wait for the county library system to get a copy. Cheap, cheap, cheap. It’s rare that I care enough about a series to pay for it.

I’ve been meaning to review a couple of cable TV series for oh, about a year now. I guess it’s time. Then I’ll get back to writing sentimental memories that will put me back on the search engine lists for stuff I never meant to be associated with. (Really? I’m now the go-to guy for Tina the Ballerina fans? Who’d have guessed? Or worse, people looking for info about permacaths are directed to my complainy post about getting one for Provenge treatments. Oh well. I hope they’re not too annoyed.)

Today’s topics: cancer, and comedy.

You know, when your life and future get blasted by a cancer diagnosis, and you’re reeling from this impossible turn in your destiny, you’re hit with all kinds of emotions. Usually within a few minutes’ time, you can careen from panic to fear to hopelessness and anger, then cycle through who-knows-what-else before you know what hit you. As you start trying to make sense of it all, it’s a relief to find anyone who understands. You get to the angry stage, and it helps to find angry people. You want to be able to laugh about it, so you look for humor.

But cancer as comedy? Not so easy to pull off. Yes, I do need to laugh. Absolutely. I want to find ways to communicate the experience to others. And I know that I can’t begrudge anyone else’s need to express their experience through comedy. Still, you need to know that I’m a grouch, a man of a melancholy disposition, and I do not want anyone to try to convince me that happy thoughts and humor are the way through my valley-of-the-shadow-of-death experience. Especially if they’re making a career out of it.

However, comedy is a personal thing. I get that. What works for you may not work for me. And your openness to joking will likely vary depending on whether you’re in the lows of chemo or some other treatment, or in the highs of just getting good test results and feeling like maybe, just a little, you can laugh about it.

In the last two years there have been two attempts at cancer comedy, a cable series and a movie. I’m puzzled: Why is this the time for cancer comedy? What does this say about the perception of cancer in American society?

Let’s start with the movie:   50/50 opened nationally in September 2011. I heard that it was a thoughtful comedy about a young man with cancer and how people close to him reacted to his diagnosis. At least that’s what I gathered from reviews. I really did want to see this one, but, oh, I was busy dealing with CHEMO and didn’t have the energy. How’s that for irony?

50/50 just came out on DVD, and I now have the energy to give it a look. Will Reiser, the writer/producer who created the movie with Seth Rogen, went through treatment for neurofibrosarcoma a few years ago and is in remission. In interviews, he’s spoken about wanting to make a movie about the cancer experience, specifically about how strange and funny the experience can be.

So, with Rogen on board, it’s not surprising that 50/50 is a young-guy-cancer-comedy, “from the guys who brought you Superbad” (as the film’s web site boasts). Sure, but is it really “consistently uproariously funny”? (Come on, who writes this promotional stuff, anyway?) Well, at least give them credit for bringing young men into the arena of cancer cinema, which is typically a woman’s world.

To clarify that description, 50/50 is a movie about young single adult men who don’t have emotional depth, but who find themselves in a situation that calls for it. I was generally disappointed with the movie. I don’t recall any part of it being “uproariously funny” — in fact, the laugh-out-loud parts are all in the trailer, if that’s any indication. There is a fair share of gentle humor; the movie is actually quite reserved where it could have played many scenes more broadly. And then there’s Rogen’s character, Kyle, who is so out of his element but blusters through scenes doing what any clueless young guy would do: be self-absorbed, get drunk, and try to pick up chicks.

The problem I had with 50/50 is how the main character, Adam (Joseph Gordon-Levitt), seems to be part of a different movie than his buddy. The further he gets into treatment, the more he glides along in his own little world, blank, drawn inward, and oddly passive. This may be one way to show the sense of isolation that cancer survivors feel, even when surrounded by friends and family. This disconnection is a key theme, but the script and direction treat it both too subtly and (in Kyle’s case) clumsily.

My biggest reservation is Rogen’s character. I freely admit that I’ve never seen any of his movies, and I hear he plays Kyle as the same character that he’s done in virtually every movie he’s been in. Maybe it’s a generational thing (am I too old for his brand of guy humor?). More likely, it’s the explicitly vulgar stuff that keeps spewing out of his mouth, starting within about 30 seconds of his first appearance. I realize that his character was drawn this way to contrast with the obsessive, quiet, almost saintly Adam, but Kyle just became a weight dragging down the movie for me. There were plenty of opportunities to explore Adam’s experience that were left out, and too often Kyle’s overbearing presence neutralizes whatever meaning is developing in Adam’s reactions. And when there’s a subtle moment at the end where we’re offered a bit of redemption in Kyle’s role, I didn’t find it convincing.

However, I’ll repeat my earlier disclaimer: comedy is a personal thing. I suppose some people will find Rogen’s character hilarious; I didn’t. I do credit the writer for getting into some meaningful subjects, and keeping the story generally believable (the biggest lapse being a lose-your-license ethical violation on the part of a certain mental health provider). I liked Joseph Gordon-Levitt’s performance, although his passivity didn’t quite lead up to the big payoff that was obviously intended toward the end of the movie. The director kept the movie light and short, but some connection between Adam’s character and the rest of the movie is missing. On the whole, you have a deeply personal, quiet character sharing the screen with an absurdly obnoxious friend, and the resulting comedy never quite comes together for me.

On to cable-cancer-comedy: The Big C, a Showtime series starring Laura Linney as a crazy, funny, weird, out-of-control suburban mom with melanoma. The series has finished two seasons and will continue with at least a third, but due to Showtime’s no-internet-viewing policy, I’ve only seen the first season on DVD. And I’m very undecided at this point if anything about the show, other than Linney’s acting, makes it worth a recommendation.

The show’s creator, Darlene Hunt, credits the series producer with saying “It’s time for a cancer comedy.” Why, I don’t know. Could this be some weird homage to a show like Breaking Bad, where a high school teacher’s cancer diagnosis is the catalyst for what turns out to be an epic drug lord tragedy? In The Big C, we have  as the show’s premise that a formerly bland suburban mom suddenly turns into a wacky free spirit after her cancer diagnosis. And we are invited to share in the gleeful chaos as she starts acting really strange. Sadly, I’m not sure there will be any epic outcome to the series, at least not on the strengths of the first season.

Unfortunately, season 1 dragged on in an increasingly unbelievable stand-off: Linney’s character tells no one of her diagnosis, except the prickly old lady across the street, whose dog senses the truth. The situations in each episode became more and more unlikely, the whole thing feeling like a wishful hallucination, until the last couple of episodes. Then things got real, and the story could move on. It had the look of a series stuck in its own writing trap: “OK, we’ve got 13 episodes, and we have to hold off on Cathy telling anyone until the last two. So, what do you think—let’s introduce the characters and come up with some insane storylines to fill up the middle 10 episodes.” Didn’t quite work for me, but I know that some people loved it.

I’ve seen a little of season 2, and there may be hope. Maybe the relationships and Cathy’s sense of self will finally start developing into something believable. Maybe the humor will start to feel more natural and less contrived. Maybe, just maybe, I’ll stop being annoyed at the shallow social comedy and gratuitous sex, for the questionable side plots and less-than-believable characters. All these distractions, the R-rated candy sprinkles tossed onto these cable TV cupcakes, just annoy me. The depiction of oncology providers is fast and loose (sorry, but Cathy’s relationship with her young doctor is absurd). Too many characters play a single stereotype or a one-joke role. Too many situations have the feel of a real cancer story with the kind of smart talk that we all wish we had said at the time. What I find discouraging is that the stretch for comedy crowds out the real-emotion moments that make the series worthwhile. And there are, in the end, a few real moments that make me wish for more depth and less comedy.

C’mon, writers and producers, are you really wasting Laura Linney’s winsome performance with this … cancer comedy? The result is a series that feels fragmented, unsure of itself. It’s comedy, but it’s not comedy about cancer: it’s comedy about a woman who sees the world through a radically different filter, one in which mortality is looming. The series tosses out comedy as a distraction but can’t find its own soul in the process. (And yes, all this is subject to revision when I see season 2.)

What really gets me curious is whether there’s another producer quote that was never made public: “Hey, did you see that crazy Canadian series about a woman with breast cancer who turns into a brilliant reality-show star? We should do something like that.” There are no obvious connections between Terminal City and The Big C, but I can’t help wondering if there was something in the first series that sparked the second.

To rewind a little, Terminal City was a 10-episode series broadcast in Canada in 2005 (more recently picked up on the Sundance channel). It’s a satire of media producers, reality TV, and the transgressive extremes producers with no ethical boundaries will go to.  All this centers on a most human story—a woman is diagnosed with breast cancer—as the poker chip they’re all betting with. Within the restraint of only ten episodes, the show was forced to be quick, tough, and beautiful all at once, and it’s a moving, painful, even funny look at what a cancer diagnosis does to a family.

Maria del Mar is stunning as Katie Sampson, the woman pushed into the harsh lights of reality television who pushes back and becomes a media sensation as her life falls apart. There’s a strong interaction between del Mar and Gil Bellows as Katie’s husband Ari: even though they’re both set adrift by the cancer and seem to be flailing in their individual circles, they are the center of the story and are both riveting.

While it’s imperfect, the series plays with many ideas and characters in a very compelling way. Their three children have their own story and characterization that is both realistic and extreme. Some of the side stories are unlikely exercises in gratuitous sex and irrational violence. (So, in Canada, can you really depict underage sex so explicitly?)  The series feels rushed and incomplete toward the end. But it has a rich, dark comedy at its base that lifts it above some of the less believable twists.

The tricky thing with this series is that the crossover between media satire and the structure of the series is a trap: are we being manipulated by this story as we watch the characters and producers manipulate their audience? Is the poetic, edgy, beautiful side of this show just a mirror of the over-the-top show producers who are pushing every boundary they encounter as they try to capture the attention of a young, hip audience?

I liked the series. I really liked del Mar and Bellows, and I was drawn in by the unexpected poetry that would spill out in odd places. There are many moments where the camera lingers on images, allowing a mood to develop with no talky explanations or obvious connections to the story.

And there are many hit-and-run moments where you’re left wondering what just happened. How about this exchange, as Katie and her perplexed, jumpy co-host Jimmy, toss around a quick series of  free associations on Katie’s live broadcast, which is cleverly (?) titled No Show:

Katie: Jimmy Crib, my sidekick. A man who terrifies network executives because he doesn’t like to watch TV.

Jimmy: I like to touch. [reaches out to touch the desk microphone]

Katie: Yes, you do. [laughing]

Jimmy: [falls off the chair, gets up] I can walk.

Katie: Hey—Dr. Strangelove…

Jimmy: Breathe in the air.

Katie: Roger Waters, Pink Floyd… Taking Care of Business.

Jimmy: Greatest rock-n-roll song ever written.

Katie: Really?

Jimmy: It’s post-modern, it’s self-referential.

Katie: Jimmy Crib, you’re on fire!  Cancer.

[Jimmy pauses. Long silence.]

Jimmy: [sigh] An orchid. A white orchid.

[Another long silence. Jimmy wiggles his hands around.]

Katie: And we’ll be right back. Man, I even say it like a pro, don’t I, Jimmy?

Jimmy, the baffled blank slate to Katie’s beautiful No Show persona, delivers a central theme for the series, tossed out in a random moment. Cancer isn’t anything but the fragility of life, put in a container, waiting for us to interact with it. Is that ever-present potted orchid a symbol of Katie’s strength and beauty, or her fragile fear of cancer? Is it a defiant reminder of life in the face of stress and the threat of death? Is it just a beautiful image being used to lull us into watching a manipulative show that uses a human life for its own gains?

Whatever. I won’t try to answer that one. But I do recommend the series. With all its absurdities it captures a luminous view of life, love, and death that doesn’t fade easily.